Hazardous Malawi abortions responsible for high mortality rates

ANA

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Under the law in Malawi, abortion is only permitted when it is necessary to save the life of the woman.

New research estimates 141 000 abortions occurred in Malawi in 2015—at an annual rate of 38 abortions per 1 000 women of reproductive age — all of which indicates that abortion is common in the country.

The majority of these procedures were performed under clandestine and unsafe conditions and often resulted in complications.

The research, which was conducted by the US-based Guttmacher Institute and the Centre for Reproductive Health at the University of Malawi College of Medicine, came as a national debate is under way in Malawi on whether to liberalise the country’s abortion law by expanding the criteria under which an abortion can be legally obtained.

Under the law in Malawi, abortion is only permitted when it is necessary to save the life of the woman.

Malawi has one of the highest maternal mortality ratios in the world. There is a one in 29 chance that a 15-year-old girl in Malawi will eventually die from a pregnancy-related condition.

Unsafe abortion is one of the major causes of maternal death in the country. According to recent estimates, complications from abortion are the cause of 6 – 18 percent of maternal deaths in Malawi.

“Restrictive abortion laws do not stop abortion from occurring, they just drive it underground, forcing women to resort to clandestine procedures, which are often unsafe,” said study co-author Dr Chisale Mhango, senior lecturer at the University of Malawi College of Medicine and former director of the National Reproductive Health Service.

“Addressing unsafe abortion is an urgent public health priority.”

The new research found that in 2015, an estimated 60 percent of women who had an abortion experienced complications that required medical treatment in a health facility.

However, one in three women experiencing such complications did not receive the post-abortion care they needed.

“Helping Malawian women avoid unintended pregnancy is critical to reducing the incidence of abortion and the complications and deaths that often follow unsafe, clandestine procedures,” said Dr Chelsea Polis, senior research scientist at the Guttmacher Institute and lead author of the study.

“Our study found that in 2015, more than half of all pregnancies in Malawi were unintended, and almost one-third of those unintended pregnancies ended in abortion.”

The researchers recommended strengthening Malawi’s family planning programmes to ensure that all Malawians can use their preferred contraceptive methods correctly and consistently.

Doing so would help reduce the number of unintended pregnancies and therefore reduce the need for abortion.

They also noted the importance of continuing to expand post-abortion care services so that every woman who experienced complications from an unsafe abortion could get the care she needs.

Improving post-abortion care services requires investments to adequately staff facilities, supply the appropriate equipment and medication, and train staff in how to provide post-abortion care according to World Health Organisation guidelines.

Finally, the researchers recommended that policymakers discussing Malawi’s abortion law consider the full range of available evidence on maternal deaths and injury, and they suggested that expanding access to safe abortion care could reduce the number of women who experience complications from unsafe abortion.